Despite advances in asthma therapy, asthma morbidity has increased dramatically in the past decade, especially among inner-city minority populations. While epidemiological studies have highlighted the sociodemographic groups most at risk for illness and death, the underlying reasons for these disparities in health are not well understood. The overall objective of this project is to evaluate the factors contributing to asthma morbidity in inner-city minority populations. The specific aims are to: (1) develop an instrument to measure patient adherence to asthma control medications; (2) determine the relative contribution of low adherence to medications, inadequate patient-provider communication, and poor access to care to poor asthma outcomes; (3) test if sensitization and indoor exposure to cockroach allergen result in increased asthma morbidity; and (4) develop the protocol and perform pilot testing of an intervention to improve the outcomes of adult inner-city asthmatics. The proposed study will enroll 420 adults with persistent asthma from the Primary Care Clinic of the Mount Sinai Hospital, located in East Harlem, a community in the epicenter of the asthma epidemic. The protocol will include a comprehensive baseline interview followed by telephone questionnaires at 4- and 12-weeks. The domains covered by the baseline interview will include sociodemographics, co-morbidities, access to care, past utilization, current medications, adherence, knowledge, beliefs, psychological symptoms, quality of patient-provider communication, environmental exposure to indoor allergens, and metered dose inhaler technique. Allergen specific IgE antibodies will be used to document allergic sensitization. At 4 and 12 weeks following the baseline assessment, telephone interviews will be conducted to obtain data on asthma symptoms, quality of life, peak flow measurements, hospitalizations, emergency department visits, and unscheduled outpatient visits. In the final 11/2 years of the project, the data collected from the initial phase of this proposal will be used to develop and pilot a self-management intervention to improve the outcome of inner-city asthmatics. During the five-year project, the candidate will pursue advanced graduate work in clinical epidemiology and health services research to further develop his scientific skills.